‘When I die, let me be the last.’ Community health worker perspectives on past Ebola and Marburg outbreaks in Uganda

Englert, E. Graham; Kiwanuka, Rose; Neubauer, Leah C.

doi:10.1080/17441692.2018.1552306

Cited by 18 publications

(24 citation statements)

References 27 publications

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“…CHWs and their supervisors required appropriate training and supportive supervision for community sensitisation, awareness and risk communication during pandemic outbreaks and the lack of these was noted as a significant barrier to effective service delivery. (7, 9, 13, 16–18, 20, 21, 25, 29, 32, 34, 37, 38, 40) In most of these studies, it was reported that appropriate training in skills and knowledge related to disease outbreaks led to an improvement in awareness of the disease, screening and reporting. In qualitative studies, it was reported that there was a change in perceptions of CHWs, leading to more proactive involvement in disease prevention and control.…”

Section: Resultsmentioning

confidence: 99%

“…There is some evidence that training and availability of PPE resulted in CHWs being more confident to cope with managing the disease outbreak. (10, 13, 16, 17, 20, 40, 42)…”

Section: Resultsmentioning

confidence: 99%

“…Studies reported that improved working conditions, provision of housing allowance, equal training opportunities, transportation allowance, and improved salaries (paid on time and for a broad range of services), awards in high-profile public events contributed to better recruitment and retention of CHWs during pandemics. (13, 15, 16, 33, 34)…”

Section: Resultsmentioning

confidence: 99%

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Community health workers for pandemic response: a rapid evidence synthesis

Bhaumik

Moola

Tyagi

et al. 2020

Preprint

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Introduction: Coronavirus disease (COVID-19), a respiratory illness, first discovered in China in December 2019 has now spread to 213 countries or territories affecting millions across the globe. We received a request from National Health Systems Resource Centre, a public agency in India, for a Rapid Evidence Synthesis (RES) on community health workers (CHWs) for COVID-19 prevention and control. Methods: We searched PubMed, websites of ministries, public agencies, multilateral institutions, COVID-19 resource aggregators and pre-prints (without language restrictions) for articles on the role, challenges and enablers for CHWs in pandemics. Two reviewers screened the records independently with a third reviewer resolving disagreements. One reviewer extracted data in a consensus data extraction form with another reviewer cross-checking it. A framework on CHW performance in primary healthcare not specific to pandemic was used to guide data extraction and narrative analysis. Results: We retrieved 211 records and finally included 36 articles on the role, challenges and enablers for CHWs in pandemics. We found that CHWs play an important role in building awareness, countering stigma and maintaining essential primary healthcare service delivery. It is essential that CHWs are provided adequate Personal Protective Equipment (PPE) and appropriately trained in its usage in the early stages of the pandemic. Wide range of policies and guidance is required to ensure health systems functioning. A clear guidance for prioritizing essential activities, postponing non-essential ones and additional pandemic related activities is crucial. CHWs experience stigmatization, isolation and social exclusion. Psychosocial support, non-performance-based incentives, additional transport allowance, accommodation, child-support, awards and recognition programs have been used in previous pandemics. We also created inventories of resources with guiding notes for quick utility by decision makers on guidelines for health workers (n=24), self-isolation in the community (n=10) and information, education and counselling materials on COVID-19 (n=16). Conclusions: CHWs play a critical role in pandemics like COVID-19. It is important to ensure role clarity, training, supportive supervision, as well as their work satisfaction, health and well-being. There is a need for more implementation research on CHWs in pandemics like COVID-19.

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Section: Resultsmentioning

confidence: 99%

“…There is some evidence that training and availability of PPE resulted in CHWs being more confident to cope with managing the disease outbreak. (10, 13, 16, 17, 20, 40, 42)…”

Section: Resultsmentioning

confidence: 99%

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Community health workers for pandemic response: a rapid evidence synthesis

Bhaumik

Moola

Tyagi

et al. 2020

Preprint

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“…Since then, the pace at which governments prepared for COVID-19 notably accounted for the scenarios that each country faced. During the previous decade, Uganda has experienced various outbreaks including Ebola, Marburg, cholera and hepatitis (Englert, Kiwanuka, & Neubauer, 2019;Nanziri et al, 2020;Okello et al, 2019). This could have instilled much experience on how to respond to outbreaks.…”

Section: Resultsmentioning

confidence: 99%

Policy Decisions and Response to Fight 2019 Novel Coronavirus Disease in Uganda: A review of Attributes, Comprehensiveness and Implications to Improve Resilience to Future Pandemics

Kiwanuka¹,

Waswa²,

Alemayehu³

et al. 2020

Preprint

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Uganda experiences recurrent epidemics. However, policies enacted to prevent or prepare for future epidemics remain unclear. This paper reviews policies that are shaping responses to the Coronavirus disease (COVID-19) in Uganda. An integrative systematic review approach using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) was adopted. Databases including organizational websites, bibliographical databases, and newsletters were searched for records on policies addressing response to COVID-19. Quality appraisal was conducted using the von Wright’s logic of events framework and the AGREE II (Appraisal of Guidelines, Research and Evaluation) checklist. A descriptive qualitative narrative approach was used for data analysis. Fifteen papers are included in this review. Uganda’s preparedness to COVID-19 was initiated before the first case was identified on 21 March 2020. Most documents included in our final analysis were soft policy (nonstatutory) documents (n=10). MoH implemented four public orders: notification of COVID-19; prohibition of entry into Uganda; control of COVID-19; prevention of COVID-19; requirements and conditions of entry into Uganda. In addition, the office of the president implemented three directives as of 08 May 2020; the initial directive included preparatory instructions to the public and ministries before the first case of COVID-19 was registered. Subsequently, three other presidential directives were established; two of these instituted lockdown measures while one instituted the first phase of releasing some lockdown measures. Soft policies identified in this review included guidelines (n=4); press releases (n=4) and mitigation measures. Three out of the four guidelines were clinical practice guidelines, these include quarantine of individuals in the context of containment of COVID-19, COVID-19 preparedness and response plan-laboratory manual, and national guidelines for management of COVID-19 patients.Conclusion: Uganda has experience built from response to previous epidemics. Uganda has robust policies in place to respond to COVID-19. Comprehensive Policies integrating human capital, research and economical aspects of an epidemic can increase and better prepare Uganda for future.

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“…While the importance of CHWs' engagement in effective COVID-19 management has been well-documented, it is also essential that several precautions are taken before scaling up CHWs roles in COVID 19 management. CHWs should be provided with appropriate and adequate personal protective equipment (PPE) (76,77) and needs to be equipped with sufficient and appropriate training and supervision for community sensitization activities as well as their own protection for effective service delivery (78,79). Availability of PPE and adequate training can make the CHWs more confident of delivering the services (80,81).…”

Section: Safety and Security Of Chwsmentioning

confidence: 99%

Community Health Workers Can Provide Psychosocial Support to the People During COVID-19 and Beyond in Low- and Middle- Income Countries

Mistry

Harris‐Roxas

Yadav

et al. 2021

Front. Public Health

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The COVID-19 pandemic has been the most challenging public health issue which not only affected the physical health of the global population but also aggravated the mental health conditions such as stress, anxiety, fear, depression and anger. While mental health services are seriously hampered amid this COVID-19 pandemic, health services, particularly those of Low- and Middle- Income Countries (LMICs) are looking for alternatives to provide psychosocial support to the people amid this COVID-19 and beyond. Community Health Workers (CHWs) are an integral part of the health systems in many LMICs and played significant roles such as health education, contact tracing, isolation and mobilization during past emergencies and amid COVID-19 in many LMICs. However, despite their potentials in providing psychosocial support to the people amid this COVID-19 pandemic, they have been underutilized in most health systems in LMICs. The CHWs can be effectively engaged to provide psychosocial support at the community level. Engaging them can also be cost-saving as they are already in place and may cost less compared to other health professionals. However, they need training and supervision and their safety and security needs to be protected during this COVID-19. While many LMICs have mental health policies but their enactment is limited due to the fragility of health systems and limited health care resources. CHWs can contribute in this regard and help to address the psychosocial vulnerabilities of affected population in LMICs during COVID-19 and beyond.

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‘When I die, let me be the last.’ Community health worker perspectives on past Ebola and Marburg outbreaks in Uganda

Cited by 18 publications

References 27 publications

Community health workers for pandemic response: a rapid evidence synthesis

Community health workers for pandemic response: a rapid evidence synthesis

Policy Decisions and Response to Fight 2019 Novel Coronavirus Disease in Uganda: A review of Attributes, Comprehensiveness and Implications to Improve Resilience to Future Pandemics

Community Health Workers Can Provide Psychosocial Support to the People During COVID-19 and Beyond in Low- and Middle- Income Countries

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